Immigrants' access to healthcare: the case of Italy

For many years, female migration has remained understudied in traditional migration research: women were mainly seen as passive followers of their male "breadwinners" counterparts (Trappolini and Giudici, 2021). However, in the past few decades a growing literature started to highlight differences in migration patterns between women and men, and more attention was devoted to different health outcomes within the migrant group (Boulogne et al., 2012; Khlat and Guillot, 2017; Oksuzyan et al., 2019; Vanthomme and Vandenheede, 2019; Ichou and Wallace, 2019). Especially in those destination countries where the population is quickly ageing, such as Italy, the demand for female caregivers for old people and for families has increased dramatically in the past decades, influencing migration pathways.

The few existing studies show generally worse health among women in terms of self-rated health and a much lower or even absent "healthy immigrant effect" for female migrants compared their male counterparts: male migrants who recently migrated have significantly better health than native men, but this is not true for women (Hamel and Moisy, 2012; Hamel and Moisy, 2015; Vang et al, 2017; Khlat and Guillot, 2017; Ichou and Wallace, 2019). According to Khlat and Guillot (2017), when arriving in the host countries, migrant women have a worse health status compared to men because they traditionally migrate for family reunification rather than for work and therefore they are less subject to the "positive health selection mechanism" in their home countries. However, today more and more women migrate for purposes that are close to men's, namely, to improve the living conditions of their families. This makes migrant women also positively selected in terms of health (Trappolini and Giudici, 2021).

Certainly, gender differences in health convergence and health access to healthcare are affected by the different roles, tasks and responsibilities that men and women have in terms of social structure and by their difference in health-seeking or risk behaviours (Wandschneider et al., 2020). Moreover, gender norms differ in relation to the country of origin and may be more or less influenced by the social context of the destination country.

Little is known about gender differences in health status of the migrant population in Italy, and even less on migrant women's access to healthcare. Regarding the health status, the few existing studies highlight differences in mortality rates between men and women (Pacelli et al., 2016) and differences in the medical issues that cause hospitalization. Cacciani et al. (2019) find that migrant men are mostly hospitalised for traumas, while migrant women for reproductive health reasons. The gender differences in migrants' health by duration of stay have been analysed for the first time by Trappolini and Giudici (2021). For all the health outcomes analysed, migrant women were far less likely to be healthy compared to migrant males and this gender gap in health status was present also among Italians. The size of the gender difference was smaller among recently arrived migrants compared to long-term migrants.

Moving on to consider the access to healthcare for immigrant women, Di Napoli et al. (2022) compared Italian women and immigrant women in nine Italian regions: they found that immigrant women had fewer gynaecological examinations, fewer first examinations after the 12th week of gestational age and fewer ultrasounds. This evidence is upsetting when one considers that immigrant women account for approximately one quarter of all births and their newborns have a 70% higher risk of infant death compared to Italian newborns (Petrelli et al., 2017; Simeoni et al., 2019; Di Napoli et al., 2022).

In the present work, for what concerns the focus on gender, I will investigate immigrant women's access to preventive care and the gender differences in access to healthcare within the migrant group. Duration of stay in Italy will also be considered as a factor shaping gender differences.